Borough

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HEALTH COMMITTEE.

Annual Report

OF THE

MEDICAL OFFICER OF HEALTH

FOR 1920.

apple bv> :

J. Whitehead & Son, Printers, Ac., Bridge Street.

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To the Mayor, Aldermen, and Members of the
Borough of Appleby.

Gentlemen,

I have the honour to submit to you my Annual Report
for the year 1920, compiled in accordance with your instructions
and those of the Ministry of Health.

The advent of a new Census to be taken this year will
greatly facilitate the correct compilation of Statistics and Ratios.

My thanks are extended to your Officials who have
rendered me excellent assistance on all occasions, as also to the
members of the Medical Profession, whose willing co-operation
has been a most valuable asset towards a constructive policy of
preventive medicine.

I am, Gentlemen,

Your obedient servant,

W. BARON COCKILL,

Medical Officer of Health.

March 21st, 1921.

BOROUGH OF APPLEBY.

Annual Report of the Medical Officer of Health
for the Year ending December 31st, 1920.

Area (land and inland water)

Population (census 1911)

Population (Registrar General’s estimate)
Population (local estimate)

Inhabited houses ...

Average population per house

1876 acres.
1736

1653

1700

45i

3'74

Appleby is an ancient little Borough pleasantly situated on the
Banks of the River Eden, about 400 feet above the sea level.
It is built on red clay and surrounded by hills, except on the
North West, formed of Carboniferous Limestone, which on the
East runs back into the Pennine chain. It is well wooded all
around, and thus well sheltered, both by the natural configuration
of land and the growth of trees. The rainfall is not as great as
in many parts of Westmorland being on an average 30 to 35
inches a year.

It is a market town serving the agricultural area around; it has
no industries of its own.

Vital Statistics.

BIRTHS.

DEATHS.

INFANT

DEATHS.

Ley

iti-

Illegiti-

Legiti-

Illegiti-

Total.

mate.

mate.

c

mate.

mate

O

1

JO

a.

0

p«

5.

0

a-

15

J

0

0

0

8

0

0

0

T3

u

ifl

T3

z

-

:

^3

3

<D

u

<L>

jj

a

S

"cj

&

It

6

a

rt

a

aj

3

.0

c;

V

rt

0

E

3

a

u

%

u

(J

Cn

<*^

u

U

z

£

«

39

39

18

1 7

2

2

23.6

27

26

I5'7

3

86

250

■

102

5

Comparative Rates.

District.

Birth

Death

I nfant
Death

Appleby

23.6

i5- 7

102

Westmorland

21.6

T3 9

66

England and Wales

25.4

12.4

80

Special Death Rates per 1,000 Population.

Pulmonary

Tuberculosis

Influenza

Cancer

o'6

0

3-6

Analysis of Infant Deaths.

Cause.

1

week

weeks

2-3

weeks

weeks

under

i

month

i-3

m’ths

3-6

m’ths

6-9

m'ths

9-12

m’ths

under

1

year

Gastritis

1

1

1

Congenital

Malformation

t

r

1

Premature Birth

1

i

1

3

2

1

3

1

3

Still births notified o.

6

The amount of Poor Law Relief is indicated by the following
facts : —

Average daily population in Institutions (East Ward Union) 4.5
Annual population receiving Out-door Relief (Appleby ... 9

There is no local hospital, patients availing themselves of
accommodation at Penrith and Carlisle.

Sanitary Condition of the District.

Water. — A public supply derived from Bank Wood, 4 miles
distant is of good quality and sufficient quantity, not liable to
contamination and having no plumbe-solvent action. A constant
piped supply.

Rivers and Streams. — There is no serious pollution present; the
care of these is under the County Council.

Drainage and Sewerage. — The surface water is removed by
separate drains; the sewage is dealt with by settling tanks and land
filtration. The system is sufficient for the needs of the District.

Closet Accommodation. — about 405.

Privies ... 55.

Pail- Closets ... 2.

There were 3 privy conversions in 1920.

Scavenging. — This is undertaken by the Borough by cartage
and is efficient; refuse is deposited on land. Disinfection of
receptacles is carried out after emptying. There are 295 ashbins
which are cleared weekly and 53 ashpits emptied at suitable
intervals. There were 3 conversions in 1920.

Inspections. — All houses are inspected quarterly. The following

defects were found

Defective gullies ... ... 5

Defective traps ... ... 2

Blocked drain ... ... 1

Total 8

Number of Statutory notices served ... o

Number of Informal notices served ... 3

These have all been remedied.

7

Premises and Occupations controlled p.y
Bye-laws and Regulations.

Slaughter House ... i.

No action has been needed.

There are no underground sleeping rooms.

Schools. — The sanitary conditions and water supplies are good.
There have been no school closures.

Active co-operation exists between the School Medical Officer
and the Medical Officer of Health.

Food.

(a) Milk Supply — This is sufficient in quantity and good in
quality and the arrangements for distribution are satisfactory.

Inspection of Dairies, Cowsheds and Milkshops is regularly
carried out ; no Tuberculous milk has been found.

Milk and Cream Regulations, 1912 and 1917, are under the
control of the Police, as also the Sale of Food and Drugs Act.

Milk (Mothers’ and Children's) Order, 1918, is administered by
the County Medical Officer of Health.

( b ) Meat. — No diseased meat has been found.

The condition of the Slaughter house has been excellent.

There is no public Slaughter house.

Inspection of carcases at time of slaughtering is made from
time to time; there is always free access and any question of
diseased meat is immediately communicated to the Inspector by
the butchers themselves.

No carcase or portions of carcase have been condemned for
tuberculosis.

Registered

Licensed

Total

Slaughter Houses.

In 1914. In Jan.. 1920. In Dec., 1920.

Nil ... Nil ... Nil

1 ... i ... 1

1 ... 1 ... 1

No case of food poisoning has occurred.

(c) Other Foods.— The sanitary condition of premises where
food is prepared, stored, or exposed for sale has been good, and
no action was required respecting them.

8

Factories and Workshops.

Factories

Number.

10

Workshops

23

Workplaces

4

37

Inspections.

Notices.

40

Nil

92

Nil

l6

Nil

148

Nil

Prevalence of, and control over
Infectious Disease.

There was a small outbreak of Diptheria at the early part of the
year, and with that exception there has been little infectious
disease ; 7 cases of Diptheria occurred in 2 houses.

Diphtheria Anti-toxin is in general use.

Bacteriorological aids have been utilized whenever necessary,
and there have been no “ Carriers ” or “ Return” cases of disease.

The Diseases notifiable under the Regulations of 7th January,
1919, have been few. Malaria cases contracted the disease
abroad.

No vaccinations have been performed under the Public Health
(Small-pox) Regulations 1917.

School intimations of infectious disease have been utilized
regularly.

There has been no epidemic of Influenza. Pamphlets dealing
with the subject were distributed to all houses.

No locally contracted cases of Anthrax or Rabies have been
known.

There are no facilities for the cleansing and disinfection of
verminous persons.

There were only two cases of Pulmonary Tuberculosis notified.

Notification by Medical Practitioners is good.

Table of Notified Infectious Diseases.

Diphtheria

Pulmonary Tuberculosis
Opthalmia Neonatorium
Malaria
Erysipelas

Total 23 5

Cases. Removed to Hospital.

14 ••• 5

9

In the case of Ophthalmia Neonatorium notified, both eyes were
affected, but no permanent injury resulted.

No cases of Encephalitis Lethargica occurred.

The Maternity and Child Welfare of the District is in the hands
of the County Medical Officer of Health.

San i t a r v Administration,

1. Staff.— This consists of i Inspector who is also engaged in
Housing Work ; he is also the Borough Surveyor.

2. Hospital Accommodation , for ordinary Infectious Disease
consists of 4 Wards providing 20 beds for Scarlet Fever cases, and
16 for Diphtheria. It is situated at Ormside, 2 miles from
Appleby, and serves the whole of the Northern part of the County.
It is under the control of the Ormside Joint Hospital Board. It
is sufficient for the purpose and the administration is good.

The hospital accommodation for Small-pox is situated near
Kendal and consists of 50 beds for the use of all Westmorland
except Kirkby Lonsdale.

3. Local Acts, etc. — The following are in operation : —

Sanitary Clauses of Public Health Act Amendment Act, 1890.
Sanitary Clauses of Public Health Act Amendment Act, 1907.
Bye-laws —

Private scavenging.

Prevention of Nuisance.

New Streets and Buildings.

Markets.

The administration of these is effectively carried out.

4. Laboratoj-ies. The Combined Districts of Westmorland
have established local laboratories at Kendal, for chemical and
bacteriological examinations.

Examinations for Appleby made during the year are as
follows : —

Diptheria ... 41

Malaria ... 4

Total 45

General Housing Conditions.

Number of Houses. .. ... ... ... 451

Working Class Houses ... ... ... ... 345

New Houses erected or in course of erection ... Nil.
Population (estimated) about 1700.

IO

There were no important changes during the year, nor any
anticipated in the near future.

Extent of shortage of houses 12.

A scheme for the erection of these 12 houses has been
formulated and sanctioned, but is held in abeyance for the
present.

Overcrowding.

There is a certain amount of overcrowding, but not to a serious
extent, it is due to the size of families. No measures can be
undertaken to overcome this till more houses are built.

Fitness.

The condition of the bulk of the houses is from good to fair.

The defects are chiefly dampness and delapidations and owners
are quite willing to do all absolutely necessary repairs, etc.

No action has been taken.

The chief difficulties have arisen on account of the high prices
for repairs and the scarcity of manual labour.

There are no difficulties in connection with water supplies,
closet accommodation and refuse disposal.

Unhealthy Areas.

There are no extensive areas that can be included under this
heading, and no action has been taken nor any complaints made
during the year.

Bye-Laws.

The existing Bye-Laws work well, and there is no need for any
new ones, but some revision of existing ones is required and is
receiving attention.

Appendices.

Housing Conditions. — Statistics.
Year ended December 31st, 1920.

1.— General.

(1) Estimated Population

(2) General death rate

(3) Infantile mortality ...

(4) Death rate from tuberculosis

(5) Number of dwelling houses of all classes...

(6) Number of working class dwelling houses

(7) Number of new working class houses erected

1 700
I5‘7

■06
45 1
345
Nil.

102

1 1

2. — Unfit Dwelling Houses.

i. Inspection.

(i) Total number of dwelling houses inspected for

housing defects (under Public Health or Housing Acts) 451

(2) Number of dwelling houses which were inspected
and recorded under the Housing (Inspection of District)

Reg. 1910 ... ... ... ... ... 203

(3) Number of dwelling houses found to be in a
state so dangerous or injurious to health as to be unfit

for human habitation ... ... ... ... 1

(4) Number of dwelling houses (exclusive of those
referred to under the preceding sub-heading) found not

to be in all respects reasonably fit for human habitation Nil.

2. Remedy of defects without service of formal notices.

Number of defective dwelling houses rendered fit in
consequence of informal action taken by the Local
Authority or their officers ... ... ... 3

3. Action under Statutory Powers.

(a) Proceedings under Sec. 28 of the Housing,

Town Planning, etc. Act, 1919.

(1) Number of dwelling houses in respect of which

notices were served requiring repairs ... ... Nil.

(2) Number of dwelling houses which were
rendered fit —

(a) by Owners

(b) by Local Authority in default of

Owners

(3) Number of dwelling houses in respect of which
Closing Orders became operative in pursuance of
declaration by owners of intention to close ...

(b) Proceedings under Public Health Acts,

(1) Number of dwelling houses in respect of which
notices were served requiring defects to be remedied ... Nil.

(2) Number of dwelling houses in which defects
were remedied —

(a) by Owners

(b) by Authority in default of Owners ...

(c) Proceedings under Sec. 17 and 18 of the
Housing, Town Planning, etc. Acts, 1909.

(1) Number of representations made with a view to

the making of Closing Orders ... ... ... Nil.

(2) Number of dwelling houses in respect of which

Closing Orders were made ... ... ... Nil.

(3) Number of dwelling houses in respect of which

Closing Orders were determined, the dwelling houses
having been rendered fit ... ... ... Nil.

(4) Number of dwelling houses in respect of which

Demolition Orders were made ... ... ... Nil.

(5) Number of dwelling houses demolished in
pursuance of Demolition Orders ...

j. — Unhealthy Areas.

Areas represented to the Local Authority with a view
to improvement Schemes under (a) Part 1 or (b) or Part
2 of the Act 1890 ... ... ... ... Nil.

Number of houses not complying with the building
Bye-laws erected with the consent of the Local
Authority under Sec. 25, Plousing, Town Planning, etc.

Act, 1919 ... ... ... ... ... Nil.

Staff engaged on Housing work, with briefly the
duties of each officer ... ... ... ... One

Housing

Officer.